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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT Pty SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 NON-REFUNDABLE PERMIT / (:ALL ZUJ y63 -/b5/ FOR INSPECTIONS tx PIHtS I T tAH rrtuM UA I t IJJUtl JOB ADDRESS I Vl.'�,RZ j JC�I(TY�21P CROSS STREET BM - f APN IO,7LJ / / PARCELSIZE ^ OWNER NAMEOse N %I.1JR�b _ PHONE �} c OWNER ADDRESS (00,21 C©pP �%�i� S =_ ---- -_ CITY/STATE/ZIP _5 _QG ter], (�� CONTRACTOR Wt -3T L eNST S�/e�WXr�� 1 _ _ PHONE ._ 2-o l 3-3c /r 1 39'7 CONTRACTOR ADDRESS MA, Y, ,`� IL S17. / CITY/STATE/ZIP 1O o lam► C A LICENSE I_I C-42 ❑ oC-36 OTHER G ` NUMBL-H _ ✓J'j I� EXPIRATION DATE ZO L/0 WATER TABLE DEPTH: '70 ft GEOGRAPHICAL INFORMATION: Coordinates X Y I 1 PERC TEST # BUILDING PERMIT # LAND USE APPLICATION #_ TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION ENGINEER DESI( REPLACEMENT OUT -OF -SERVICE SEPTIC SYSTEM DESTRUCTION _ INSTALLATION WILL SERVE: %-RESIDENCE L] COMMERCIAL I I OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: 1wr v;'ho nnl HnCr n.ACAOTKACMTC ❑ GREASE TRAP TYPE/MFG DISTANCE TO NEAREST: WELL ❑ LIFT STATION SIZE TYPE OF PUMP .TERNATIVE .... .. ...... - Jam. .. _. _ _.... ... .. ...-... _ CAPACITY gal # OF COMPARTMENTS It FOUNDATION ft PROPERTY LINE ft _ U PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) LEACH LINES ;LEACHING CHAMBERS_ # OF LINES 3 LENGTH OF LINES S -S ft DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE ft ❑ FILTER BED WIDTH _ ft LENGTH ft DEPTH It DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft ❑ MOUNDED WIDTH It LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE ft _ _ ] SUMPS WIDTH 1 ft LENGTH I y ft DEPTH w It DISTANCE TO NEAREST WELL 1S 12 + ft FOUNDATION I o k It PROPERTY LINE S ft ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH It DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft SEE PITS NUMBER 3 WIDTH 31 ft DEPTH � S ft DISTANCE TO NEAREST WELL (SO ♦ ft FOUNDATION In ft PROPERTY LINE I&J ft I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MY REQUIRED LICENSE IS CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL WORKERS COMPENSATION LAWS. MINI URDVA E NOTICE REQUIRED FOR INSPECTIONS - PLE SE CALL 209 953-7697 '2 SIGNED TITLE DATE Application Accepted Final Inspection By Character of Soil to� COMMENTS =000000 f' �3"Itz" DEPARTMENT USE ONLY yL Date t" A' Area e_ Employee ID#_j Date Z Z /❑ SPECIIA0,044— A�� PE/R. MIT -Approved by of 3 Ft: Gr/ x Pit/Sump Soil Character: A0,0• 4 PE SC INFO Received B Check#/ Cash Amount Remitted Date Permit/Code Service Request # Invoice # Permit ID# 42.01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 5/5/17 T r